Case log

[anbuitachi]

Anyone here know what counts as high risk delivery for logging cases in ACGME? Any recent or current residents here? Do you also log all cases that you are part of including if you relieved the 1st resident? Cause theres no way of differentiating on ACGMEs logger whether you came in mid way, at the end, or did entire case

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[deleted171991]

Anyone here know what counts as high risk delivery for logging cases in ACGME? Any recent or current residents here? Do you also log all cases that you are part of including if you relieved the 1st resident? Cause theres no way of differentiating on ACGMEs logger whether you came in mid way, at the end, or did entire case

Seriously, you can't tell which pregnancy is high risk and which is just average? Go back to your books.

Theoretically you can log almost any case you have signed into for a meaningful period. Practically is up to your personal ethics what you consider worth logging, from an educational standpoint.

 

[AdmiralChz]

Anyone here know what counts as high risk delivery for logging cases in ACGME? Any recent or current residents here? Do you also log all cases that you are part of including if you relieved the 1st resident? Cause theres no way of differentiating on ACGMEs logger whether you came in mid way, at the end, or did entire case

FFP is correct above, I logged any case I was there for a meaningful time. So no lunches, and not always if I relieve the CRNA's knee ORIF which was closing. But if I took over shortly after a case started, it got logged I just didn't log an airway if I didn't do it. You shouldn't be hurting for cases so bad you need to log 20 minutes of involvement.

Look in any textbook for high-risk definitions. Off the top of my head (and some may not consider them high risk): VBAC/TOLAC, severe preeclampsia, placenta previa, placenta acreta (much more likely for C/S), maternal comorbidities like congenital heart disease/DM1, multi gestation.

 

[Pharmado]

High risk pregnancies are high risk deliveries. Risk factors for pregnancy complications include multiple gestational, pre-e, anything with abnormal placenta (previa, percreta, abruption etc), even advanced gestational age counts. There are many things that count and how you log them is up to you. Whether you log every case you set foot in or just those you start is up to you. I think you'll find that WAY before the end of residency you'll be tired of logging cases and either stop completely, stuck to the index cases, or grimace when you log things. Don't stress it, it is not a big deal, it is just a necessary evil.

 

[anbuitachi]

Oh i guess every delivery is high risk hahaha. Vbac, tolac?? who isn't a vbac tolac hahah.
Oh and textbook? Do people still read these days?? I just go on wikipedia

 

[Libertas]

Oh and textbook? Do people still read these days?? I just go on wikipedia

 

[dchz]

FFP is correct above, I logged any case I was there for a meaningful time. So no lunches, and not always if I relieve the CRNA's knee ORIF which was closing. But if I took over shortly after a case started, it got logged I just didn't log an airway if I didn't do it. You shouldn't be hurting for cases so bad you need to log 20 minutes of involvement.

Look in any textbook for high-risk definitions. Off the top of my head (and some may not consider them high risk): VBAC/TOLAC, severe preeclampsia, placenta previa, placenta acreta (much more likely for C/S), maternal comorbidities like congenital heart disease/DM1, multi gestation.

Welcome to Texas, you have to get used to BMI > 45. I would add super morbid obese and repeat x3 or more to the list.

It's all a moot point though, there are no requirements from the acgme for high risk delivery.

 

[AdmiralChz]

Oh i guess every delivery is high risk hahaha. Vbac, tolac?? who isn't a vbac tolac hahah.
Oh and textbook? Do people still read these days?? I just go on wikipedia

There are many OB groups/hospitals who don't do VBAC/TOLAC, typically more in the community setting where there likely isn't an in-house OB or anesthesiologist to handle imminent problems. You aren't likely to rotate at such places as a resident.

It's an immediate referral to an MFM or an OB affiliated with a tertiary center who is comfortable doing such things, I saw two uterine ruptures with failed TOLACs in residency and it was pretty scary stuff.

 

[anbuitachi]

Uh would a C section for failure to descend or progress a high risk delivery..? theres nothing special about the c section, just that the vaginal delivery is taking longer than expected...

 

[nimbus]

Here's a link of peripheral interest. It was eye opening for me to see the deaths that occur after initial discharge.

Lost Mothers

 

[anbuitachi]

Here's a link of peripheral interest. It was eye opening for me to see the deaths that occur after initial discharge.

Lost Mothers

I just read this. kind of infuriating. the incompetence is real out there. i knew something would be off when they recommended the obgyn cause he's a 'good doctor' nice guy. Unfortunately being a nice guy doesn't necc make you a good doctor if you are clinically incompetent. The dood set preclampsia at 180/110. Like what? Nurses took off the BP cuff cause her pressure is high so theres no point in measuring? Are you serious? Not only do they need to be sued, they need to be fired too